老年射血分数中间值心力衰竭患者的临床特点分析

摘要

Objective To study the cause,clinical characteristics and treatment of HFmrEF,HFrEF and HFpEF patients.Methods Three hundred and eighty-five heart failure (HF) patients aged ≥60 years admitted to our hospital from January 2016 to March 2017 were divided into HFrEF group (n=96),HFmrEF group (n=34) and HFpEF group (n=255) according to their ejection fraction.Their demographic data,HF cause,clinical characteristics,cardiac ultrasonographic data,laboratory testing data and therapies were recorded.Their clinical characteristics were compared.Results The number of males was greater and the cardiac function grade Ⅳ was higher in HFmrEF group than in HFrEF and HFpEF groups.The incidence of hypertension was the highest followed by that of valvular disease.The number of HFmrEF patients who used intravenous nitrates,spironolactone and milrinone was greater than that of HFpEF and HFrEF patients who used intravenous nitrates,spironolactone and milrinone.The serum creatinine level was higher in HFmrEF patients than in HFpEF and HFrEF patients at the time when they were discharged.Conclusion Hypertension and valvular disease are the mian risk factors for HFmrEF.The number of males is greater and the cardiac function grade Ⅳ is higher in HFmrEF patients than in HFrEF and HFpEF patients.The serum creatinine level is higher and the outcome is better in HFmrEF patients than in HFrEF and HFpEF patients at the time when they are discharged.%目的 了解老年射血分数中间值的心力衰竭(HFmrEF)患者与射血分数减低的心力衰竭(HFrEF)及射血分数保留的心力衰竭(HFpEF)患者的病因、临床特点和治疗情况差异.方法 入选2016年1月～2017年1月我院心力衰竭中心因心力衰竭住院的年龄≥60岁患者385例,按LVEF分为HFrEF组96例、HFmrEF组34例和HFpEF组255例.收集患者的人口学资料、心力衰竭病因、临床特点、心脏超声、检验结果和治疗情况,比较各组患者临床综合特征的差异.结果 HFmrEF组高血压比例最高(67.7％),瓣膜疾病比例次之(29.0％).HFmrEF组住院期间静脉用硝酸酯类(44.1％vs 25.0％和16.5％)、出院肌酐[(131.66±55.7)μmol/L vs (80.49±33.97)μmol/L和(85.50±37.81)μmol/L]明显高于HFrEF组和HFpEF组;应用螺内酯和米力农的比例低于HFrEF组,而高于HFpEF组(P＜0.05,P＜0.01).结论 高血压、瓣膜疾病是老年HFmrEF的主要病因;且以男性和心功能Ⅳ级居多;此类患者出院肌酐水平偏高;同时,这部分老年心衰患者的转归尚可.